Healthcare Provider Details

I. General information

NPI: 1801987441
Provider Name (Legal Business Name): STEVIN A DUBIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST ROOM2144
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

3468 STALLINGS ISLAND RD
MARTINEZ GA
30907-9544
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3873
  • Fax: 706-721-7763
Mailing address:
  • Phone: 706-267-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number028535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: